Reflective practice in medical education

Reflective practice may sound like an easy thing to do, but when taken seriously, and done in earnest, it is a rewarding, engaging, and sometimes challenging activity, that can motivate you to explore theories of learning and teacher practices, improve your own practices and enrich your understandings of the teaching and learning process.

According to de Cossart and Fish (2005) reflection is about:

  • seeking to uncover rigorously and understand and articulate the relationship between one’s visions, values and beliefs, and one's thought, knowledge and action, in reference to specific examples of one's own practice;
  • having an exploratory cast of mind, that is both critical and meticulous,
  • processes which crucially include contextualizing one's practice, viewing and investigating it critically, and exploring open-mindedly how it relates to wider understandings of that practice and the practice of one's profession;
  • understanding our practice better, and thus being motivated and committed to improving it, and thereby being equipped to go about such improvement.

In that sense, reflective practice is a special kind of practice, which involves systematic critical enquiry into one's professional work and one's relationship to it. (de Cossart & Fish, 2005, p. 75)

Later they specify that reflective practice:

  • Involves a careful consideration of one's own practice through systematic critical enquiry;
  • involves investigating practice from as many points of view as possible;
  • creates opportunities for professional growth and development because it aims at better understanding of practice;
  • involves standing back from practice and offers the possibility of thinking about it from outside the existing traditions or established patterns of practice;
  • is about reviewing (re-viewing) practice in all its aspects;
  • is about practitioners coming to an understanding of their actions, their espoused theories and theories-in-use;
  • includes moral questions about the worthwhile nature of activities themselves, and thus attends to ends as well as means;
  • engages us in critical thinking;
  • does not replace one set of dogmas with another;
  • does not come in pre-determined forms;
  • is a particularly intimate mode of educational research;
  • is a concept eternally being worked out.

The specific activities and attributes of successful reflection include a combination of: description; analysis; interpretation; appreciation; self-awareness; self-criticism (what ought to be the case but isn't); imagination (seeing the world through the eyes of others and from as many points of view as possible); creativity (in capturing the richness of the moment in vivid ways); synthesis (making connections between action and theory and general principles – where ‘theory’ means what others have understood, distilled, made public, and refined against critique) (de Cossart & Fish, 2005, p. 77).

Reflection and evaluation

Reflection is crucial to the evaluation cycle. With any enactment of learning facilitation, we can take the opportunity to gather evaluation data and follow through the steps in the evaluation cycle (see Figure). But reflection also stands alone as one of the four sources of data about our practices as teachers. The “reflecting self” is a source of data for evaluation purposes, and the act of reflecting is part of the action learning cycle – the process by which data inform continuous improve through reflection and re-design.

(adapted from Bath et al., 2004, p. 45)



Bath, D., Smith, C., & Steele, C. (2004). A tutor’s guide to teaching and learning at UQ. The University of Queensland.

Cleland, J., & Roberts, T. E. (2013). Medical education research. In J. A. Dent & R. . Harden (Eds.), A practical guide for medical teachers (4th ed., pp. 400–413). Elsevier.

de Cossart, L., & Fish, D. (2005). Cultivating a thinking surgeon: new perspectives on clinical teaching, learning and assessment. tfm Publishing Ltd.

It is important that any scholar, whether in medical education or any other area of endeavour, is aware of his or her pre-conceptions and scientific assumptions and how these could be problematic as well as helpful.  Reflection is a skill, an attitude, and a mental habit of consideration and analysis of the why, how and what-ifs of situations. Reflection is about standing in a different place and seeing things from a different perspective, and ultimately doing things differently, e.g. asking 'Why do I do things the way I do?' and 'Why do I think this?'  It can be particularly useful to reflect on your own values, feelings, thinking and actions, as well as the context of a situation… Reflection not only increases one’s self-awareness but also can influence competence. You may well already use reflection in the context of thinking about your clinical practice. Reflection is important, and often neglected, element of scholarship. (Cleland & Roberts, 2013, p. 405)